In the face of strict surveillance by the new Chief of Medicine Maddox, the hospital staff struggles to maintain their patient-centric approach. Dr. Cox and Elliot find their ability to work the system for patients' benefits hampered. Elliot's naïveté about hospital operations, like being charged for candy, contrasts with Cox's savvy. Interns, particularly Katie, strive to impress superiors amidst these challenges. The episode highlights the staff's frustrations and strategies to navigate bureaucratic constraints, culminating in a collective effort to oust Maddox. Personal growth is evident, particularly in Katie's confession about her work ethics, symbolizing a shift towards a more cohesive, supportive hospital culture.